In this thesis, we tried to find opportunities for improving anticoagulation care. Both older (VKAs) and newer (DOACs) anticoagulants have been addressed. Several determinants in VKA treatment could identify risk subgroups and predict adverse clinical outcomes. These determinants were mostly linked to the quality of anticoagulation. Clinical findings such as a minor bleeding as a risk indicator for a major bleeding independent of the quality of VKA anticoagulation, may also be of significance to DOAC care.
Anticoagulation, regardless of the anticoagulant used, is a risky, but also a sometimes burdensome treatment. However, in contrast to the belief of some physicians we found that VKA treatment was well tolerated by AF patients in real life. We tried to find some factors associated with DOAC treatment-related quality of life. Especially better information at the start of anticoagulant treatment and providing contact information might be achievable measures for the improvement of anticoagulation-related quality of life.
We also made a proposal for a new and optimal organization of anticoagulation care. An essential part is an annual ‘anticoagulation weighing consultation’, for every anticoagulated patient. In addition to balancing the risks and benefits of the anticoagulation treatment, education and information should be addressed in this consultation.
The implementation of this renewed organization may lead to better safety and quality of life for anticoagulated patients. By more regional cooperation in anticoagulation care, as proposed, the opportunities for clinical research will be increased. In due course, these opportunities may lead to improved anticoagulation care.
Prof. Dr .K. Meijer